Parent/Guardian Name

Enter the full name of the parent or guardian signing this form.

This field is required.

Child’s Name(s)

Enter the full name of your child(ren).

This field is required.

Child’s Age

Enter your child’s age(s) in years.

This field is required.

Emergency Contact Name

Enter the name of an emergency contact person.

This field is required.

Emergency Contact Phone

Enter a phone number to reach the emergency contact.

This field is required.

Medical Conditions

List any medical conditions or allergies your child may have.

Consent to Participate

I give consent for my child to participate in the children’s yoga class.

This field is required.

By ticking this box, I, the parent/guardian of the above child, confirm that:- The information provided above is correct and complete to the best of my knowledge.- I understand that yoga involves physical activity and there is always a risk of injury.- I will inform the class instructor of any changes to my child’s health prior to each session.- I understand that I am responsible for my child at all times while attending the class.- I release the organisers and instructors of Move & Meditate from any liability for injuries sustained during the yoga session, except in the case of negligence.

This field is required.

Photo Release

I grant permission for photos of my child to be used for promotional purposes.

I consent to allowing Move and Meditate to store my submitted personal information so they can respond to my inquiry and add me to their mailing list.

This field is required.

Move and Meditate Waiver Form